Muscoskeletal conditions [completed] Flashcards
What is the role of the muscle tendon in the joint?
Attaches the muscle to the bone
What is the role of muscle in the joint?
Contracts and relaxes to create movement. Working alongside the tendon
What is the role of the ligament in the joint ?
The ligament is bands of tissues that connect bones together to give the joint strength and stability. It prevents abnormal movement.
what is the synovial bursa and what is its role?
Small fluid filled sacs that reduce friction to protect the tissue it lies between. Less friction = less wear and tear
Where can a synovial bursa be found?
Between:
two tendons
a tendon and skin
skin and bone
tendon and bone
What is inflammation of the bursa called?
bursitis
What are some causes for inflammation, swelling and pain in muscoskeletal conditions?
Wear and tear (age-related?)
Strain (unaccustomed use)
Overuse (acute or chronic)
Trauma (Acute)
What is important to establish when assessing symptoms in common muscoskeletal conditions?
If it is due to acute or chronic disorder.
- Look at history and patterns
- Usually an obvious cause if acute (e.g. sports injury) whereas chronic causes are harder to establish
What can systemic symptoms alongside joint symptoms suggest?
Inflammatory or chronic conditions - aura, prodromal symptoms like fever and fatigue common with RA and gout
What are common causes of neck pain?
Strain on ligaments and muscles from unaccustomed movement or positions such as lifting wrong or being sat at a desk all day
What are some example of common conditions that affect the neck?
Wry neck (Acute torticollis)
Prolapsed disc
Arthritis
What is wry neck (ACUTE TORTICOLLIS)?
When the neck only hurts when moved in a certain way. It is usually self limiting (1-2 days) and presents in people with no history of neck problems
What causes wry neck?
The neck being bent or twisted and muscle is spasming. -> often when a person sleeps weird, turns too quickly or going suddenly from hot to cold weather
How does arthritis in the neck present?
Equally painful on BOTH sides of the neck but CAN be one side. Gradual onset as usually due to wear and tear.
What is capsulitis (Frozen shoulder) ?
Inflammation of the supporting tissue (tendons) in the shoulder
What is the cause for capsulitis?
overuse or unaccustomed movement
How does capsulitis present?
Pain and restricted movement in one or all directions
Why may there still be restricted movement after the shoulder has healed from capsulitis? How long can this last?
Tissue scarring and fibrosis of the muscles and tendons due to chronic overuse. Movement restriction can be permanent.
What are the two sections of the upper back called?
Cervical and thoracic
What are the three sections of the lower back called?
Lumbar
Sacral
Coccyx
What would need to be excluded if a person is presenting with pain in the thoracic area and how?
Cardiovascular causes so look for:
- history of heart problems
- angina
-what kind of pain? radiating could be heart attack
- pallor, and sweaty
What could cause pain from straining of intercostal muscles between the ribs?
- Coughing
- lifting heavy items from back instead of from legs
What would strains/muscle tears in the upper back feel like?
sharp pains in a defined area that worsens when breathing in and coughing. person may feel discomfort when eating.
What should we do if a person’s breathing is affected AND they have a sharp continuous pain in their chest?
REFER - may be a pulmonary embolism
What is lumbago?
pain of the lower back
What is the cause for mild lumbago?
strain of spinal muscles and ligaments
What are the causes for severe lumbago?
Vertebrae, disc and associated joint disorders
What age group is lumbago most common in?
People in their 30s and 40s
Do patients with lumbago experience pain at rest or on slow movement?
No
When should lumbago be referred?
If lasting over 3-4 weeks
What are the discs in between veterbrae?
Disc are circular pads of tissue that are gel on the inside and have a tough outer casing. They minimise friction between vertebrae.
What is a herniated/prolapsed disc?
When the disc between the vertebrae shape changes and the gel pushes through on the outer casing. This causes impinging on the nerve root.
What are the signs of a slipped disc?
Sudden severe back pain
Stiff gait
Pain when sitting or at rest
Referred pain due to impingement on nerve roots
What is the most common nerve affected by slipped discs?
Sciatic nerve - nerve that goes from lower back into leg
What is sciatica?
Impingement on sciatic nerve causing referred pain in the leg.
According to NICE guidelines when should sciatica be suspected?
- Pain in one side/legthat goes below the knee
- Lower back pain not as intense as leg pain
- Numbness, tingling , parastheia and muscle weakness
How long does sciatica take to settle?
4-6 weeks but may take longer in some patients
What is the first line drug management for sciatica?
Ibuprofen or naproxen with a PPI
What is the second line drug management for sciatica?
codeine with or without paracetamol but opioids should be avoided where possible
Should paracetamol be offered alone for sciatica?
NO
What is some self management advice that can be given to patients with sciatica?
- HEAT: hot water bottles, heat patches
- Place a small firm cushion between knees when sleeping on the side or propping the knees up with a pillow if lying on the back
- Simple exercises
- Staying active, resume normal activities and work as soon as possible
What is ankylosing spondylitis?
Inflammatory arthritis of the lumbar spine and joints in the SACRAL area.
When does ankylosing spondylitis typically present?
Young adulthood
Is there a genetic factor to ankylosing spondylitis?
Yes
Is ankylosing spondylitis more common in males or females?
males
What can we ask a patient presenting with ankylosing spondylitis symptoms to confirm likelihood?
If their parents, especially their father had similar symptoms
True or false. Ankylosing spondylitis gets better after rest.
False. Gets worser and stiffer after rest especially right after waking up but improves with exercise
What can happen over time in ankylosing spondylitis?
There is inflammation of the ligaments and calcification where ligaments attach to bones in the spine so the vertebrae begin to fuse.